PA.35 In-Utero Transfers: The Impact of Senior Clinical Discussion on Transfer Decision-Making

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Abstract

Introduction

In-Utero Transfers (IUTs) are integral to modern perinatal services. Decisions to organise an IUT have not always involved Senior Medical Staff. The Scottish Government Maternity Services Action Group and Neonatal Services Review (2009) recommended that clinical decision-making for IUTs should be underpinned by guidelines to facilitate safe transfers. A Perinatal Advisory Service (PAS) was established in the West of Scotland (WoS) in 2011, tasked with integrating Senior Clinician input, both Obstetric and Neonatal, early in the triage of potential transfers, by introducing a Conference Call process, as this was predicted to be clinically advantageous.

Aim

To explore the impact of Senior Clinical discussion on key transfer decisions for IUT requests to the PAS.

Methods

PAS transfer decision-making was prospectively analysed for consecutive IUT contacts between October 2011 to December 2013.

Results

334 potential IUT referrals were made to the WoS PAS. 285 (85%) prompted a Conference Call, of which 216 (76%) involved direct Consultant-to-Consultant dialogue. The actual numbers of IUTs organised following the Conference Call clinical discussion was 256 (77% of initial contacts). Conference calls reduced the requirement for transfer by 10% (n = 29). 97% of calls were within the key performance indicator of 60 min. No deliveries occurred during transit.

Conclusion

Senior decision-making and clinical decision support, facilitated by conference calling, within the PAS service may modestly reduce the requirement for IUT, reducing the inappropriate use of finite ambulance resources and avoiding the unwanted consequences emotionally and financially of unnecessary geographical relocation for mother and fetus.

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